Fertility Preservation Pathways in Young Women With Breast Cancer: A Single-Center Analysis in a Publicly Funded System

BACKGROUND: Fertility concerns are central to the care of young women with breast cancer. Cancer treatments and chemotherapeutic regimens may adversely affect reproductive potential. Despite extensive attention to fertility preservation (FP), reported uptake remains low. It remains unclear how patients progress through the fertility preservation process within publicly funded health care systems that reduce financial and access barriers. METHODS: Key time points in the patient care sequence were assessed, beginning with the initial oncology or surgical consultation, at which fertility discussion (FD), defined as counseling by an oncologist or breast surgeon, could occur, followed by fertility consultation (FC), defined as consultation with a fertility specialist, and uptake of FP, including oocyte, embryo, or ovarian tissue cryopreservation, but not hormonal ovarian protection. RESULTS: Among 248 women, 77.8% had FD, 40.7% underwent FC, and 27.4% proceeded to FP. The largest reduction occurred between the FD and the FC, whereas progression from consultation to preservation remained high. Although women aged 40 years or older and those with two or more children were less likely to proceed to FC and FP, they still represented a measurable proportion of those undergoing preservation. CONCLUSION: Fertility discussions were documented for most patients, and progression from FC to FP was high. The overall proportion of women undergoing FP was higher than previously reported in earlier studies. These findings suggest that previously reported low utilization rates may not fully capture patients' interest in FP and may, in part, be attributable to differences in patterns of care delivery.